Over the past decade or so, the predominant patient-centered ethos in American bioethics has come under attack by critics who claim that it is morally deficient in certain respects, particularly when viewed in the context of acute-care decisionmaking. One line of criticism has been that the current ethic of patient autonomy gives an individual competent patient far too much decisional authority over the terms of his own treatment so that the patient is at complete liberty to neglect the ways in (...) which his medical decisions can drastically and negatively affect the lives of other family members. Given that family members must help shoulder the financial, emotional, and rehabilitative burdens involved in the patient's care, it has been argued that they too have a legitimate interest in choosing what sort of medical treatment the patient eventually receives. Another closely related line of criticism is that the prevailing focus on patient autonomy gives short shrift to the moral significance of the family as a genuine community. Echoing a view of the person advanced by most communitarian political theorists, some commentators have argued that the patient comes to the clinic so thoroughly embedded in a complex web of familial relationships and obligations that it does not make sense to identify him as the only person in the family to make decisions about treatment. (shrink)

: Many adolescent patients with chronic medical conditions do not manage their illnesses very closely and often put themselves at risk for serious health complications. Setting aside cases of nonadherence that are due to practical difficulties involving the implementation of a management plan, a deeply problematic question remains. How should health care providers respond to adolescent patients who express a conscious and value-driven decision to pursue other goals and interests that are incompatible with their doctors' recommended directives? Using two guiding (...) ethical principles, the "relevant difference principle" and the "principle of noninterference," as well as available empirical data on adolescent decision making and risk perception, the paper concludes that most adolescents ages 14 and older should be allowed to make self-determining decisions regarding the management of their chronic medical conditions. (shrink)